[Cancer of the cheek in a patient under etanercept]

Etanercept (Enbrel) is a TNF-alpha inhibitor effective in rheumatoid polyarthritis, psoriatic rheumatism, ankylosing spondyloarthritis, chronic plaque psoriasis, and juvenile idiopathic arthritis. Several cases of tumours have been described in patients under etanercept. However, no case of association with oral carcinoma had ever been described. The aim of this study was to report a case of carcinoma of the cheek mucosa in a patient treated with etanercept for rheumatoid polyarthritis.

An 82-year-old female patient, non smoker, consulted for a tumour of the oral cavity. History revealed that this lesion had appeared soon after the initiation of etanercept treatment for severe and resistant rheumatoid polyarthritis. Clinical observation revealed a tumour of the right cheek mucosa 5 by 3 cm. The lesion was superficially infiltrative, budding in spots, and verrucous. The clinical observation was otherwise normal. The histological examination of the surgical piece revealed a micro-infiltrative and non-invasive orthoplastic epidermoid carcinoma.

The possible development of an oral cavity carcinoma should be taken into account when following a patient under TNF-alpha inhibitor treatment. Anti-TNF treatment has improved the management of patients with severe chronic inflammatory diseases. They allow for a better quality of life. Nevertheless, their immunosuppressive effect should be taken into account when prescribed and during follow-up.